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Consumer Complaint Form (On Line & PDF)

 

Howard County Department of Citizen Services
Office of Consumer Affairs

Consumer Complaint Form (Downloadable PDF) 

 

Complaint Number (to be assigned by staff)_______________

 

Consumer Information

Name      

Address  

Daytime Telephone Number  

E-mail Address  

 

Business Information

Name  

Address  

Telephone Number  

E-mail Address  

Web Address  

 

Date of Contract or Service  

Date You Complained to the Business  

Description of Complaint 

 

 

List Documents You Have That Relate to your Complaint

 

Please send copies (not originals) of these documents to the Office of Consumer Affairs: by mail (5761 Columbia Gateway Drive, Columbia MD, 21046),  fax (410-313-6453) or e-mail consumer@howardcountymd.gov).

  

What Resolution Are You Seeking?

 

 

How did you hear about the Office of Consumer Affairs?

 

 

 

Under State and County laws, the information you provided in this complaint form

becomes public information when the case is closed and placed in our inactive files.

 

Signature (enter your initials here)  

Date